268863 (AR)BUILDING PERMIT
DEPARTMENT OF BUILDING,& SAFETY
COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMATE t `� NO. ELECTRICAL FEES
1 ST FL. �';r"� SQ.FT. @ J/ I.� 7 "'- UNITS
2ND FL. SQ. FT. @
POR. 50. FT. @ MOBILEHOME SVC.
GAR. SQ. FT. @ POWER OUTLET
CAR P. SO.FT. @
-:::]
WALL SQ. FT. @
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $
NOTE: Not to be used as property tax valuation
MECHANICAL FEES
VENT SYSTEM ❑ FAN ❑ EVAP. COOL (A`HOOD a
SWIM POOL, PVT
SWIM POOL, COMM
SIGN
�FI�S OFFICE
NO. PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATERSOFTENER
WASHER (Atl @11IDISHI
fi
z IU0
APPLIANCE
� SP NO
JOB ADDRES�S}p 37,04
�'0�"37,0 4ors- dTuAReiz
OWNER
/,f' 1,10 f
]5
USE OF PERMIT ADD l -re HE A/ w I
F. C.
GARBAGE DISPOSAL
PE MIT NO.
76
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
�— _l�
6 8 863
M H PERMIT FEE
LAUNDRY TRAY
$
AIR HANDLING UNIT
CFM
UNITS
IDLE METER
VALUATION
SUPP. TO PERMIT
KITCHEN SINK
;2 476
ABSORPTION SYSTEM
B.T.U.
TEMP USE PERM SVC
WATER CLOSET
erg
COMPRESSOR
HP
COPIES
POLE, TEMP/PERM
LEGAL DESCRIPTION
ry _� ,
�� 'rJU Q! ' %IO- lj�'b S,4A17A 'K'i'/�sf/T/F
LAVATORY
DBL
$
HEATING SYSTEM Cl FORCED ❑ GRAVITY
BACK
AMPERES SERV ENT c m
49 010
SHOWER
GRP
TYPE CK BY
BOILER � B.T.U.
/SET
CL'
SQ FT @ ¢
/
BATHTUB
�AiX
F D S R'� /
PLAN CHECK FEE
SQ FT @ C
BOND AMT.
WATER HEATER
PLAN CHECKER
FINAL DATE
IN TOR
-�� SQ FT RESID @ J
.L�1 tfi�
SEWAGE DISPOSAL
:� 77
CONSTRUCTION FEE
SQ FT GARAGE @ '/a¢
$
/
HOUSE SEWER
U
PERMIT FEE
'l1)
.06
GAS PIPING
!7D
MOBILE HOME PERMIT FEE
$
$
PERMIT FEE
.00.
PERMIT FEE
j
CQ
PERMIT NO.
268863
TOTAL FEES
/00
MOB. HM.FEE
MICRO FEE
MECH. FEE
p—U
DBL.
PL. CK. FEE
�, a'
CONST. FEE
yon'
DBL.
ELECT. FEE
1 �a
D.I.SMI
FEE
y.
FEE
PLUMB. FEE
s�
DBL.
J I F I M I A I M I J J q I S 1 Q 1 N I D
74
� SP NO
JOB ADDRES�S}p 37,04
�'0�"37,0 4ors- dTuAReiz
OWNER
/,f' 1,10 f
]5
USE OF PERMIT ADD l -re HE A/ w I
F. C.
DATE
PE MIT NO.
76
��� ro ziolN� Roo" r>�J
�— _l�
6 8 863
M H PERMIT FEE
$
COMMUNITY
DST
UNITS
ROOMS
VALUATION
SUPP. TO PERMIT
OFFICE
/� a411 A/
erg
r
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
ry _� ,
�� 'rJU Q! ' %IO- lj�'b S,4A17A 'K'i'/�sf/T/F
MECHANICAL FEE
DBL
$
BACK
LOT SIZE ZONE
USE NO.
GRP
TYPE CK BY
/SET
CL'
40
/
�AiX
F D S R'� /
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE
IN TOR
�®
00
:� 77
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
'l1)
.06
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
/
STRONG MOTION
$
"/AGE 'S S GNATUR J /
CONTRACTOR
INSTRUMENTATION FEE
$
ADDRESS
ADDRESS
FEE
` T�A (
PLUMBING FEE
DBL
$
CITY ZIP CODE
/A 6'+
CITY ZIP CODE
6 •
5-0
,
TOTAL FEES
$ to
3
TEL, NO,
-:
TEL. NO. LICENSE
I
CASH ❑ CHECK M.O. ❑ N.C. ❑
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSA
A,"oN OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
RECEIVED BY
TREES REQUIRED
Lo
�, I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN AC
Xl CORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSC
SEWAGE SYSTEM
--Tp-
6
T
LL
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THI
!r I
I I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPAREDTHEPLANS AND SPECIFICATIONS
FORM 284.208 (Rev. 10-74) (2)L HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.